Fever (Department meeting 2/4/24) Flashcards
What is this stain?
How is it done?
Ziehl Neelson stain
What does acid fastness mean?
What substance in the cell wall in AFB is responsible is responsible for this property?
Name another bacterium with similar property.
- Resistance to decolorization by acids during laboratory staining procedures
- Mycolic acids (long chain fatty acids)
- Nocardia
Describe the MRI sequences
Describe the abnormality
Describe the abnormality
Sputum, urine, stool, blood were negative for bacterial culture and AFB smear, what would you do next?
Name one additional test to confirmed the presence of Mycobacterium tuberculosis.
PCR
Bone marrow aspirate shows macrophages engulfing haemopoietic cells including eosinophils and erythroid precursors –> known as haemophagocytosis
FeverPancytopeniadLFTRaised ferritinRaised TG HypofibrinogenemiaHemophagocytosis
What is your dx?
What are the common triggers/ causes?
Hemophagocytic lymphohistiocytosis (HLH) / Macrophage activation syndrome (MAS)
Infections
Viral (EBV, CMV, HIV, hantaviruses, HEV, H5N1, SARS coronavirus)
Bacterial (mycoplasma pneumoniae, salmonella typhi, legionalla pneumophila, MTB, orientia tsutsugamushi)
Fungal (aspergillus, fusarium, talaromyces marneffei, cryptococcus neoformans)
Protozoal (toxoplasmosis, strongyloides stercoralis)
Malignancies
Autoimmune diseases
Microscopic appearance: mould form, characteristic conidial heads
Talaromyces marneffi (formerly known as penicillium marneffei) is a dimorphic fungi. Different forms at different temp (25 degrees is mould) at 37 degrees is yeast
BAL shows what
Cytological examination showed a larva of strongyloides
RF for strongyloides stercoralis?
Importance of eosinophilia?
Rhabtidiform larvae in the gut become infective filariform larvae that can penetrate either the intestinal mucosa or the skin of the perianal area, resulting in autoinfection.
58/M
AML post sibling HSCT
FLT3-ITD, DNMT3A
Ruxolitinib 10mg BD for 16 months for cGVHD
Concurrent immunosuppressants: nil
Comorbidities: cGVHD liver and mouth
Please comment on the CXR
What is next Ix?
Diffuse bilateral pulmonary infiltrates (increased pulmonary vasculature)
CT thorax
Comment on the CT images
Name 1 further Ix
Extensive patchy GGO (ground glass opacity) in bilateral lungs
FOB (fibreoptic bronchoscopy) with BAL (+ve for pneumocystic jirovecii on silver stain)
What stain and organism?
Cysts of pneumocystis jirovecii on silver stain from BAL
RF for pneumocystis jirovecii
- AIDS
- Haematological malignancies/HSCT
- Isolated cases of pneumocystis pneumonia (PCP) and the use of ruxolitinib
What is workup?
CBC/ clotting profile/biochemistry
CXR
Blood/urine culture
CT brain
Comment on CT brain
What is next step?
Right occipital hypodense lesion
MRI brain